How to properly behave with a sick person, how to respond to the main symptoms of the disease - hallucinations, delusions and confused thinking? Alcoholic delirium and its consequences

Description:

Delirium (lat. Delirium) - a set of ideas and ideas, inferences that did not arise from information received from the outside world and is not corrected by the incoming new information (it does not matter whether the delusional conclusion corresponds to reality or not), a component of productive symptoms with and others psychoses.
Causes of delirium:

* oxygen;

* ;

Symptoms:

Sharp delirium. If the delirium completely takes possession of consciousness, then such a state is called acute delirium. Sometimes the patient is able to adequately analyze the surrounding reality, if this does not concern the subject of delirium. Such nonsense is called encapsulated.
Being a productive psychotic symptomatology, delusions are a symptom of many diseases of the brain, but it is especially characteristic of schizophrenia.
Interpretive (Primary, Primordial, Verbal). In interpretive delirium, the primary is the defeat of thinking - rational, logical knowledge is affected, the distorted judgment is consistently supported by a number of subjective evidence that has its own system. This type of delusion is distinguished by its persistence and tendency towards progression and systematization: “evidence” is added into a subjectively coherent system (at the same time, everything that does not fit into this system is simply ignored), more and more parts of the world are drawn into the delusional system.
Hallucinatory (Secondary, Sensual, Explanations). Hallucinatory delusions resulting from impaired perception. This is figurative nonsense, with a predominance of illusions and. Ideas with him are fragmentary, inconsistent - primarily a violation of sensory cognition (perception). Violation of thinking comes a second time, there is a delusional interpretation of hallucinations, the absence of conclusions, which are carried out in the form of insights - bright and emotionally rich insights. Another reason for the development of secondary delusions can be affective disorders. The manic state causes delusions of grandeur, and depression is the root cause of ideas of self-abasement. Elimination of secondary delirium can be achieved mainly by treating the underlying disease or symptom complex.

The plot of delusion, as a rule (in cases of interpretive delusion), is not actually a symptom of the disease and depends on the socio-psychological, as well as cultural and political factors, within which the patient is located. At the same time, several groups of delusional states are distinguished in psychiatry, united by a common plot. These include:

      * delusions of persecution (persecutory delusions)
      * delirium of attitude - it seems to the patient that the whole surrounding reality is directly related to him, that the behavior of other people is determined by their special attitude towards him
      * delirium of reformism
      * delirium of love (Clerambault's syndrome) - almost always in female patients: the patient is convinced that a famous person loves him (her), or that everyone who meets him (her) falls in love with him (her)
      * religious nonsense
      * antagonistic nonsense (including Manichaean nonsense)
      * delusions of litigation (querulism) - the patient is fighting for the restoration of "trampled justice": complaints, courts, letters to management
      * delusions of jealousy - belief in the betrayal of a sexual partner
      * delirium of origin - the patient believes that his real parents are high-ranking people, or that he comes from an ancient noble family, another nation, etc.
      * delirium of damage - the belief that the patient's property is spoiled or stolen by some people (as a rule, people with whom the patient communicates in everyday life)
      * delusions of poisoning - the belief that someone wants to poison the patient
      * nihilistic nonsense (typical for TIR) - a false feeling that he, others or the world around him does not exist or the end of the world is coming
      * hypochondriacal delirium - the belief of the patient that he has some kind of disease (usually serious)
      * The so-called nervous in most cases is also a delusional construction.
      * nonsense of staging (intermetamorphosis) - the patient's belief that everything around is specially arranged, scenes of some kind of performance are played out, or an experiment is being conducted, everything constantly changes its meaning: for example, this is not a hospital, but in fact the prosecutor's office; the doctor is actually an investigator; patients and medical staff - security officers disguised in order to expose the patient.

Causes of occurrence:

      Delirium (lat. Delirium) - a set of ideas and ideas, inferences that did not arise from information received from the outside world and is not corrected by incoming new information (it does not matter whether the delusional conclusion corresponds to reality or not), a component of productive symptoms in case of schizophrenia and other psychoses.
Causes of delirium:
      *Mental disorders
      * infection;
      * oxygen starvation;
      * Violation of the acid-base balance in the body;
      * depression;
      * injury;
      * alcohol or drug poisoning;
      * drug side effects;
      * drug interactions.

Treatment:

For treatment appoint:

Treatment is always difficult enough. If assistance has to be provided on the street, the patient must be immediately isolated (for this, one usually has to resort to the help of police officers); if this happened in a general hospital ward, then other patients should be removed, leaving only those who can really help. It is also necessary to remove all piercing and cutting objects that can be used as an attack weapon. You should not take the calming of the patient as a result of the first medicamentous effects for recovery: the whole complex of measures for the supervision of the patient should be carried out with the same care.
Treatment should begin with drug relief of motor excitation. More often use chlorpromazine, tizercin, droperidol or chlorprothixene. With the dominance of hallucinatory phenomena in the clinic, haloperidol is added (1 - 2 ml of a 0.5% solution intramuscularly). BP should be constantly monitored; cordiamin is used as a stimulant of the vasomotor center. It is necessary to follow the general trend of a gradual transition from injection administration of drugs to oral administration.
The patient must be continuously monitored, for which others can be involved; if necessary, resort to physical fixation. It is highly desirable through persuasion (for which one should spare neither time nor effort) to obtain from the patient consent to taking medications. In a hospital setting, the paramedic must monitor not only the regularity of taking psychotropic drugs, but also the development of the so-called side effects of therapy.

People often use the word "nonsense". They thus express their disagreement with what the interlocutors are talking about. It is rare enough to observe really crazy ideas that manifest themselves in an unconscious state. This is closer to what is considered nonsense in psychology. This phenomenon has its own symptoms, stages and methods of treatment. We will also consider examples of delusions.

What is delirium?

What is delusion in psychology? This is a mental disorder when a person expresses painful ideas, conclusions, reasoning that do not correspond to reality and are not subject to correction, while unconditionally believing in them. Other definition of delusion is the falsity of ideas, conclusions and reasoning that do not reflect reality and are not amenable to change from the outside.

In a delusional state, a person becomes egocentric, affective, because he is guided by deeply personal needs, his volitional sphere is suppressed.

People often use this concept, distorting its meaning. So, delirium is understood as incoherent, meaningless speech that occurs in an unconscious state. Often observed in patients with infectious diseases.

Medicine considers delirium as a thought disorder, not a change in consciousness. That is why it is a mistake to believe that delirium is an appearance.

Brad is a triad of components:

Ideas that are not true.
Unconditional faith in them.
The impossibility of changing them from the outside.

The person does not have to be unconscious. Quite healthy people can suffer from delirium, which will be discussed in detail in the examples. This disorder should be distinguished from the delusions of people who misunderstood the information or misinterpreted it. Delusion is not delusion.

In many ways, the phenomenon under consideration is similar to the Kandinsky-Clerambault syndrome, in which the patient has not only a thinking disorder, but also pathological changes in perception and ideomotor.

It is believed that delirium develops against the background of pathological changes in the brain. Thus, medicine refutes the need to use psychotherapeutic methods of treatment, since it is necessary to eliminate the physiological problem, and not the mental one.

Stages of delirium

Brad has stages of its development. They are the following:

Delusional mood - the conviction of the presence of external changes and impending disaster.
Delusional perception is the effect of anxiety on a person's ability to perceive the world around them. He begins to distort the interpretation of what is happening around.
Delusional interpretation is a distorted explanation of perceived phenomena.
Crystallization of delusion - the formation of stable, comfortable, fitting delusional ideas.
Attenuation of delirium - a person critically evaluates the available ideas.
Residual delirium is a residual phenomenon of delirium.

To understand that a person is delusional, the following system of criteria is used:

The presence of the disease on the basis of which the delirium arose.
Paralogic - building ideas and conclusions based on internal needs, which makes you build your own logic.
Absence of impaired consciousness (in most cases).
The “affective basis of delusion” is the inconsistency of thoughts with actual reality and the belief in the correctness of one’s own ideas.
The immutability of nonsense from the outside, stability, "immunity" to any influence that wants to change the idea.
Preservation or slight change in intelligence, since when it is completely lost, delirium disintegrates.
Destruction of personality due to concentration on a delusional plot.
Delusion is expressed by a stable belief in its authenticity, and also affects the change in personality and his lifestyle. This should be distinguished from delusional fantasies.

With delirium, one need or an instinctive model of actions is exploited.

Acute delirium is isolated when a person's behavior is completely subordinate to his delusional ideas. If a person maintains clarity of mind, adequately perceives the world around him, controls his own actions, but this does not apply to those situations that are associated with delirium, then this type is called encapsulated.

Symptoms of delirium

The psychiatric help website highlights the following main symptoms of delusions:

Absorption of thought and suppression of the will.
Inconsistency of ideas with reality.
Preservation of consciousness and intellect.
The presence of a mental disorder is the pathological basis for the formation of delirium.
The appeal of delirium to the person himself, and not to objective circumstances.
Complete conviction in the correctness of a crazy idea that cannot be changed. Often it contradicts the idea that a person adhered to before its appearance.

In addition to acute and encapsulated delusions, there are primary (verbal) delusions, in which consciousness and working capacity are preserved, but rational and logical thinking is disturbed, and secondary (sensual, figurative) delusions, in which the perception of the world is disturbed, illusions and hallucinations appear, and the ideas themselves fragmented and inconsistent.

Figurative secondary delirium is also called delirium of death, since pictures appear like fantasies and memories.
Sensual secondary delusions are also called delusions of perception, because they are visual, sudden, rich, specific, emotionally vivid.
The delusion of the imagination is characterized by the emergence of an idea based on fantasy and intuition.

In psychiatry, there are three delusional syndromes:

Paraphrenic syndrome - systematized, fantastic, combined with hallucinations and mental automatisms.
Paranoid syndrome is an interpretive delusion.
Paranoid syndrome - unsystematized in combination with various disorders and hallucinations.

Separately, paranoid syndrome is distinguished, which is characterized by the presence of an overvalued idea that occurs in paranoid psychopaths.

The plot of delirium is understood as the content of the idea that regulates human behavior. It is based on the factors in which a person is: politics, religion, social status, time, culture, etc. There can be a large number of delusional plots. They are divided into three large groups, united by one idea:

Delirium (mania) of persecution. It includes:

Delusion of damage - other people of a person plunder or spoil his property.
Delirium of poisoning - it seems that someone wants to poison a person.
Relationship delusions - people around are perceived as participants with whom he is in a relationship, and their behavior is dictated by their attitude towards a person.
Delusion of influence - a person thinks that his thoughts and feelings are influenced by external forces.
Erotic delirium is a person's confidence that he is being pursued by a partner.
Delirium of jealousy - confidence in the betrayal of a sexual partner.
The delusion of litigation is the belief that a person has been treated unfairly, so he writes letters of complaint, goes to court, etc.
The nonsense of staging is the belief that everything around is rigged.
The delusion of possession is the conviction that a foreign organism or evil spirit has entered the body.
Presenile delirium - depressive pictures of death, guilt, condemnation.

Delusions (mania) of grandeur. Includes the following forms of ideas:

The delusion of wealth is the belief in the presence of untold riches and treasures in oneself.
The delusion of invention is the belief that a person must make some new discovery, create a new project.
The nonsense of reformism is the emergence of the need to create new rules for the good of society.
Descent delusion - the idea that a person is an ancestor of the nobility, a great nation, or the child of rich people.
The delusion of eternal life is the idea that a person will live forever.
Love delusions - the belief that a person is loved by everyone with whom he has ever communicated, or that famous people love him.
Erotic delusions - the belief that a particular person loves a person.
Antagonistic nonsense - the belief that a person is a witness to some kind of struggle of the great world forces.
Religious nonsense - presenting oneself in the form of a prophet, messiah.

Depressive delusion. It includes:

Hypochondriacal delusions are the idea that there is an incurable disease in the human body.
Delirium of sinfulness, self-destruction, self-abasement.
Nihilistic nonsense - the lack of a sense that a person exists, the belief that the end of the world has come.
Cotard syndrome - the belief that a person is a criminal who is a threat to all mankind.

Induced delirium is called "infection" with the ideas of a sick person. Healthy people, often those who are close to the sick, adopt his ideas and begin to believe in them themselves. It can be identified by the following signs:

An identical crazy idea is supported by two or more people.
The patient, from whom the idea came, has a great influence on those who are "infected" with his idea.
The environment of the patient is ready to accept his idea.
The environment is uncritically related to the ideas of the patient, so they accept them unconditionally.

Examples of delusions

The types of delusions discussed above can be the main examples that are observed in patients. However, there are a lot of crazy ideas. Let's look at some of their examples:

A person can believe that he has supernatural powers, what to assure others and offer them a solution to problems through magic and witchcraft.
It may seem to a person that he is reading the thoughts of others, or vice versa, that the people around him are reading his thoughts.
A person may believe that he is able to recharge through the wiring, which is why he does not eat and stick his fingers into the outlet.
A person is convinced that he lives for many years, was born in ancient times, or is an alien from another planet, for example, from Mars.
A person is sure that he has twins who repeat his life, actions, demeanor.
The man claims that insects live under his skin, which multiply and crawl.
The person is making up false memories or telling stories that never happened.
A person is convinced that he can turn into some kind of animal or inanimate object.
A person is sure that his appearance is ugly.

In everyday life, people often throw the word "nonsense". Often this happens when someone is under the influence of alcohol or drugs and tells what happened to him, what he sees, or states some scientific facts. Also, expressions with which people do not agree seem to be crazy ideas. However, in fact, this is not nonsense, but is considered just a delusion.

Clouding of consciousness can be attributed to delirium when a person sees something or the world around him is poorly perceived. This also does not apply to delirium by psychologists, since what is important is the preservation of consciousness, but the violation of thinking.

Delusion treatment

Since delirium is considered a consequence of brain disorders, the main methods of its treatment are medicines and biological methods:

Antipsychotics.
Atropine and insulin coma.
Electrical and drug shock.
Psychotropic drugs, neuroleptics: Melleril, Triftazin, Frenolon, Haloperidol, Aminazine.

Usually the patient is under the supervision of a doctor. Treatment is carried out in a hospital. Only when the condition improves and there is no aggressive behavior, outpatient treatment is possible.

Are psychotherapeutic treatments available? They are not effective because the problem is physiological. Doctors direct their attention only to the elimination of those diseases that caused delirium, which dictates the set of drugs that they will use.

Only psychiatric therapy is possible, which includes medications and instrumental effects. There are also classes where a person tries to get rid of his own illusions.

Forecast

With effective treatment and elimination of diseases, a complete recovery of the patient is possible. The danger is those diseases that are not amenable to modern medicine and are considered incurable. The prognosis becomes unfavorable. The disease itself can become fatal, which affects life expectancy.

How long do people live with delusions? The very state of a person does not kill. His actions, which he commits, and the disease, which can be fatal, become dangerous. The result of the lack of treatment is isolation from society by placing the patient in a psychiatric hospital.

It is necessary to distinguish delirium from the usual delusions of healthy people, which often arise on emotions, misperceived information or its insufficiency. People tend to make mistakes and misunderstand something. When there is not enough information, a natural process of guessing occurs. Delusion is characterized by the preservation of logical thinking and prudence, which distinguishes it from delirium.

In modern psychiatry, delirium (synonyms: mental disorder, delirium) is a complex of ideas or ideas that appeared as a result of a developing brain disease as a symptom. They erroneously reflect reality and are not corrected by new incoming information, regardless of whether the existing conclusion corresponds to reality or no. Most often, delusions are one of the components of the manifestations of schizophrenia or other

In what cases does the word "nonsense" have synonyms - "mental disorder" and "insanity"

But in order to talk about the presence of a mental deviation in a patient, one cannot start only from the content of the idea that has seized him. That is, if for others it looks like complete nonsense, this cannot serve as proof that a person has

In delirium, it is not the content that falls out of the generally accepted ideas that is painful, but the violation of the course of a person’s life associated with it. A delusional patient is removed from the world, uncommunicative, he is isolated in his conviction, which greatly changes his appearance and life values.

Features of crazy ideas

A delusional belief is not amenable to any correction from the outside. Unlike the delusions of a healthy person who firmly defends his point of view, delirium is a kind of unshakable idea that does not require real confirmation, since it exists regardless of the events taking place in reality. Even the negative experience of following a crazy idea does not force the patient to abandon it, and sometimes even, on the contrary, strengthens faith in its truth.

Since the delusional idea is always very closely fused with the cardinal personality changes that have arisen earlier, it necessarily causes radical changes in the patient's attitude towards himself, the outside world, turning him into a "different person".

Delirium is often accompanied by the so-called psychic automatism syndrome or alienation syndrome, in which the patient has a feeling that any of his actions or thoughts do not occur of his own free will, but are invested or inspired from outside, by an extraneous force. In these cases, patients suffer from delusions of persecution.

Paranoid delusions are the result of distrust of the environment

Paranoid delusions are formed from opposing oneself to the environment and distrust of other people, transforming over time into extreme suspicion.

The patient at some point begins to understand that everyone around him is treated unfairly, infringes on his interests, humiliates him. Due to the inability of the paranoid to interpret the actions and words of others, this belief develops into a paranoid syndrome.

In psychiatry, it is divided into three types.

Delusions of influence, in which the patient is convinced of the influence from the outside on his behavior and thoughts.
Delusional relationship, when a person assumes that others are talking about him, laughing at him, looking at him.
Paranoid nonsense. This state is expressed in the patient's deep conviction that some mysterious forces desire his death or harm him in every possible way.

By the way, the latter type of thinking disorder in certain situations can be easily transmitted to the environment of the patient, which leads to an incident that is characterized as induction, that is, borrowing the beliefs of a sick person to a healthy one.

What is induced delirium

In psychiatry, this phenomenon is called "induced delirium." This is an induced, borrowed belief that the patient's environment adopts from the patient - those who are in the closest contact with him and have not developed a critical attitude towards the patient's pathological condition, since he is an authority in this group or is trusted.

Induced in such cases begin to express the same ideas and present them in the same form as the patient-inducer. The person who induced the delusion is, as a rule, a suggestible person who is subordinate to or dependent on the source of the idea. Most often, but not always, the dominant person (inducer) is diagnosed with schizophrenia.

It should be noted that this disorder , as well as the initial delirium of the inductor, this is a chronic condition, which, according to the plot, turns out to be delusions of grandeur, persecution, or religious delusions. Most often, groups that find themselves in cultural, linguistic or territorial isolation fall under this influence.

Under what conditions can a diagnosis be made?

In order to correctly diagnose, it should be remembered that induced delirium is:

a condition in which several people share the same crazy idea or system built on it;
support each other in the named conviction;
such people have very close relationships;
even passive members of this group are induced after contact with active partners.

When contact with the inductor ceases, the views grafted in this way most often dissipate without a trace.

How Does Hypochondriacal Delusion Occur?

In psychiatric practice, another type of thought disorder is often encountered - hypochondriacal delusions. characterized by a deep conviction of the patient that he has a serious incurable disease or a shameful one, one that is not amenable to conventional therapy.

The fact that doctors cannot find her, the delusional person perceives only as their incompetence or indifference. The data of analyzes and examinations for such patients are not proof, because they have a deep conviction in their own unique illness. The patient seeks more and more examinations.

If the hypochondriacal delusion begins to grow, then the idea of persecution, which the doctors allegedly organized in relation to the patient, joins it. These symptoms are often accompanied by the previously mentioned delirium of exposure, which is supported by the conviction that the disease is caused by specially organized radiation, which destroys internal organs and even the brain.

How does hypochondriacal delirium change

Sometimes in patients with hypochondriacal delusions, its change occurs to the idea of the opposite content - that the patient was always absolutely healthy or, most often, that he was suddenly completely healed. As a rule, such delirium is a consequence of a change in mood caused by the disappearance of (usually shallow) depression and the appearance of a hypomanic state.

That is, the patient, as he was, remained fixed on the topic of health, but now his delirium changes its vector and, having become a delirium of health, is directed to the healing of others.

By the way, many so-called traditional healers who distribute personally invented methods of curing all ailments have the described category of thought disorder. At best, such methods are simply harmless, but this is quite rare!

How delirium becomes systematized

Interestingly, the delusional constructions in all the above cases are interconnected, consistent and have some logical explanation. Such a disorder of thinking indicates that we have a systematized nonsense.

This disorder is most often seen in people who have a good level of intelligence. The structure of systematized nonsense includes the material on the basis of which the idea is built, as well as the plot - the design of this idea. With the development of the disease, it can be colored, saturated with new details, and even change direction, as shown above.

By the way, the presence of systematized delirium always confirms its long existence, since an acute onset of the disease, as a rule, does not have a harmonious system.

Delusion is a false judgment that completely captures the consciousness of a person and cannot be corrected, despite the obvious contradiction with reality. Delusion is considered one of the leading signs of insanity, since most often psychoses that occur in both mental and somatic diseases are accompanied and manifested precisely by delirium.

reforming or inventing;
relationships, for example, erotic, with the conviction that this or that person is in love with him;
greatness;
jealousy;
hypochondriacal delirium;
delusions of influence;
persecution.

Delusions can occur as a separate symptom, as well as in the form of paranoid, paranoid and paraphrenic syndromes, which are called delusional.

Paranoid syndrome is represented by a systematized delirium, that is, having a structure, "pseudo-logic", mainly on one specific topic. A person's ideas spread to others and rarely affect him as the suffering side. This is the mildest delusional syndrome. It is not accompanied by hallucinations or delusions of the senses. At the same time, the mood in a person is usually elevated, complacency and confidence in one's superiority are noted. In thinking, obsession with details, viscosity, and thoroughness are characteristic.
In paranoid syndrome, in addition to delusional ideas, a person has a feeling of fear, anxiety, discomfort from the feeling of his own and the surrounding "change", pseudohallucinations.
Paraphrenic syndrome is considered the most severe in terms of the depth of violations. Crazy ideas with him can be of very different content, spread to several topics or areas at once, be ridiculous, artsy, often fantastic. At the same time, a person may be in a strongly depressed or elevated mood, which is accompanied by a feeling of euphoria, gaiety or fear, panic, a premonition of a catastrophe. With paraphrenic delusional syndrome, both true and false hallucinations are noted.

Diseases accompanied by delirium

Delusion, in the form of a symptom and delusional syndromes, occurs in the following diseases and conditions:

With the development of a chronic delusional disorder, in which a person has paranoid personality traits - suspicion, hostility, incredulity. These qualities can be formed under the influence of genetic mechanisms, under the influence of a totalitarian upbringing, when they enter society or are involved in specific activities related to surveillance and behavior control.
Schizophrenia is characterized by polythematic delusions affecting different spheres of life, which are accompanied by emotional and volitional disorders, impaired thinking.
With affective disorders - mania and depression. In manic-depressive psychosis, delirium is rarely observed in the manic phase, while individual delusional ideas are clearly associated with the emotional background, euphoria. In the depressive phase, delusional ideas are in the nature of self-abasement, belittling one's moral and physical qualities.
With lesions of the vessels of the brain. Vascular diseases of the brain (hypertension, cerebral atherosclerosis, and others), including psychotic manifestations in their picture, are usually observed in people over 45 years of age. In terms of content, there are usually delusional ideas of “damaging”, for example, material or in the form of ideas of poisoning, witchcraft, and influence.
With other organic lesions of the brain - infectious, traumatic, intoxication or degenerative genesis (for example, with dementia, alcoholism), as part of a hallucinatory-paranoid syndrome. For these disorders, the presence of hallucinations is mandatory, and the delusions that arise are "secondary" and serve to supplement or explain perceptual deceptions. At the same time, a person has mood disorders, episodes of disturbed consciousness are possible.

Diagnostics

The following are used as diagnostic tools:

collecting an anamnesis of life and concomitant diseases;
a conversation with relatives to clarify the condition in which the symptom arose;
toxicological analysis of blood and urine;
examination of the brain to identify and exclude organic pathology;
experimental psychological research (EPI).

Treatment

When choosing a treatment, it is required to conduct a differential diagnosis between these disorders, in order to determine the underlying disease, within which delusions are observed.

Drug treatment is represented by antipsychotics, but usually therapy is difficult, as a person often refuses to take medication, does not trust doctors. Hospitalization may be required.

Later it was supplemented by the statement that delusions arise only on a pathological basis. Therefore, Bleikher V. M., traditional for the national school of psychiatry, gives the following definition:

Another definition of delirium is given by G. V. Grule (German) Russian : "establishing a connection of a relationship without a reason", that is, the establishment of a relationship between events that cannot be corrected without a proper basis.

Existing criteria for delirium include:

Within medicine, delusions fall within the realm of psychiatry.

It is fundamentally important that delirium, being a disorder of thinking, that is, the psyche, at the same time is a symptom of a disease of the human brain. Treatment of delusions, according to the ideas of modern medicine, is possible only with biological methods, that is, mainly with drugs (for example, antipsychotics).

According to research conducted by W. Griesinger (English) Russian in the 19th century, in general terms, delirium on the mechanism of development does not have pronounced cultural, national and historical features. At the same time, the pathomorphosis of delirium is possible: if in the Middle Ages obsession, magic, love spells prevailed, in our time there is a frequent delirium of influence by telepathy, biocurrents or radar.

Often in everyday life, mental disorders (hallucinations, confusion), sometimes occurring in somatic patients with elevated body temperature (for example, with infectious diseases), are mistakenly called delirium.

Classification

If delirium completely takes possession of consciousness, then such a state is called acute delirium. Sometimes the patient is able to adequately analyze the surrounding reality, if this does not concern the subject of delirium. Such nonsense is called encapsulated.

Being a productive psychotic symptomatology, delusions are a symptom of many diseases of the brain.

Primary (Interpretive, Primordial, Verbal)

At interpretive delirium the primary is the defeat of thinking - rational, logical knowledge is affected, the distorted judgment is consistently supported by a number of subjective evidence that has its own system. At the same time, the perception of the patient is not disturbed. Patients can remain functional for a long time.

This type of delusion is persistent and tends to progress and systematization: "proofs" add up to a subjectively coherent system (at the same time, everything that does not fit into this system is simply ignored), more and more parts of the world are drawn into a crazy system.

This variant of delusions includes paranoid and systematized paraphrenic delusions.

Secondary (sensual and figurative)

hallucinatory delusion resulting from impaired perception. This is nonsense with a predominance of illusions and hallucinations. Ideas with him are fragmented, inconsistent - the primary violation of perception. Violation of thinking comes a second time, there is a delusional interpretation of hallucinations, the absence of conclusions, which are carried out in the form of insights - bright and emotionally rich insights. Elimination of secondary delirium can be achieved mainly by treating the underlying disease or symptom complex.

There are sensual and figurative secondary delusions. With sensual delirium, the plot is sudden, visual, concrete, rich, polymorphic and emotionally vivid. This is delusional perception. With figurative delirium, scattered, fragmentary representations arise according to the type of fantasies and memories, that is, delirium of representation.

Syndromes of sensual delusions:

Syndromes develop in the following order: acute paranoid → staged syndrome → antagonistic delusions → acute paraphrenia.

The classic variants of unsystematized delusions are paranoid syndrome and acute paraphrenic syndromes.

In acute paraphrenia, acute antagonistic delusions, and especially staging delusions, the syndrome of intermetamorphosis develops. With it, events for the patient change at an accelerated pace, like a film that is shown in fast mode. The syndrome indicates an extremely acute condition of the patient.

Secondary with special pathogenesis

delusions of imagination

Delusional Syndromes

Currently, in domestic psychiatry, it is customary to distinguish three main delusional syndromes:

delusional relationship- it seems to the patient that all the surrounding reality is directly related to him, that the behavior of other people is determined by their special attitude towards him;
nonsense meaning- a variant of the previous plot of delirium, everything in the environment of the patient is given special importance;
delusions of influence- physical (rays, devices), mental (as an option according to V. M. Bekhterev - hypnotic), forced sleep deprivation, often in the structure of the syndrome of mental automatism;
option erotic delusions without positive emotions and with the conviction that the partner is allegedly pursuing the patient;
delusions of litigation (querulism)- the patient is fighting for the restoration of "trampled justice": complaints, courts, letters to management;
delusions of jealousy- belief in the betrayal of a sexual partner;
delirium of damage- the belief that the patient's property is being spoiled or stolen by some people (as a rule, people with whom the patient communicates in everyday life), a combination of delusions of persecution and impoverishment;
delusions of poisoning- the belief that someone wants to poison the patient;
delusions of staging (intermetamorphoses)- the patient's conviction that everything around is specially arranged, scenes of some kind of performance are played out, or an experiment is being conducted, everything constantly changes its meaning: for example, this is not a hospital, but in fact the prosecutor's office; the doctor is actually an investigator; patients and medical staff - security officers disguised in order to expose the patient. Close to this type of delirium is the so-called "Show Truman syndrome";
delusions of possession;
presenile dermatozoic delirium.

Induced ("induced") delirium

Main article: induced delusional disorder

In psychiatric practice, induced (from lat. inducer- “induce”) delirium, in which delusional experiences are, as it were, borrowed from the patient in close contact with him and the absence of a critical attitude to the disease. There is a kind of “infection” with delusion: the induced begins to express the same delusional ideas and in the same form as the mentally ill inducer (dominant person). Usually induced by delirium are those persons from the environment of the patient who communicate especially closely with him, are connected by family and kinship relations.

Psychotic illness in a dominant person is most often schizophrenic, but not always. The initial delusions in the dominant person and the induced delusions are usually chronic and are by the plot delusions of persecution, grandeur, or religious delusions. Typically, the group involved has close contacts and is isolated from others by language, culture, or geography. The person who is induced into delirium is most often dependent on or subservient to a partner with a true psychosis.

The diagnosis of induced delusional disorder can be made if:

one or two people share the same delusion or delusional system and support each other in this belief;
they have an unusually close relationship;
there is evidence that the delusion was induced in a passive member of a couple or group by contact with an active partner.

Induced hallucinations are rare, but do not exclude the diagnosis of induced delusions.

Stages of development

Differential Diagnosis

Delusions must be distinguished from delusions of mentally healthy people. In this case, firstly, there must be a pathological basis for the occurrence of delirium. Secondly, delusions, as a rule, relate to objective circumstances, while delirium always refers to the patient himself. In addition, the delirium contradicts his previous worldview. Delusional fantasies differ from delusions by the absence of a strong belief in their authenticity.

Literature

Delirium // Thinking disorders. - K.: Health, 1983.
Kerbikov O.V., 1968. - 448 p. - 75,000 copies. ;
N. E. Bacherikov , K. V. Mikhailova , V. L. Gavenko , S. L. Rak , G. A. Samardakova, P. G. Zgonnikov , A. N. Bacherikov , G. L. Voronkov . Clinical Psychiatry / Ed. N. E. Bacherikova. - Kyiv: Health,. - 512 p. - 40,000 copies. - ISBN 5-311-00334-0;
Guide to Psychiatry / Ed. A. V. Snezhnevsky. - Moscow: Medicine,. - T. 1. - 480 p. - 25,000 copies.;
Tiganov A.S. Hallucinatory-paranoid syndromes // General psychopathology: a course of lectures. - Moscow: LLC "Medical Information Agency", . - S. 73-101. - 128 p. - 3000 copies. -